Clinical scholarship during a longitudinal integrated clerkship - - PowerPoint PPT Presentation

Clinical scholarship during a longitudinal integrated clerkship community research project

Kathryn M Weston, Judy R Mullan, Peter L McLennan, Warren C Rich, Pippa Burns

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• 4-year graduate-entry course
• Early and longitudinal clinical experience
• Includes a 12-month longitudinal community-based

integrated clerkship in Phase 3

Phase 1 Phase 2 Phase 3 Phase 4 Year 1 Year 2 Year 3 Year 4

UOW MEDICAL DEGREE

• Scholarship is a highly regarded academic pursuit, typically

relating to university-based research (viz Boyer 1990)

• Clinical settings offer a different perspective on scholarship
• Recent literature (Grigsby & Thorndyke 2011) has

advanced the notion of ‘clinical scholarship’

• Includes aspects such as using a scientific approach to

solve clinical problems, influence beyond the clinical setting, and improving health.

SCHOLARSHIP

GRIGSBY AND THORNDYKE 2011

• systematic observation and scientifically based methods to identify,

describe, and solve clinical problems

• ccurs in throes of practice; potential for learning how to improve

clinical practice

• not limited solely to what occurs in the traditional clinical setting of the

hospital, outpatient clinic, or clinical practice

• broad scope, beyond a disease process, into lives of patients and

families, community arena

• ften interdisciplinary; knowledge and methods from other disciplines

to enhance understanding

• knowledge and expertise generated in clinical scholarship is of value.

Helps us anticipate trends, needs; track and manage processes,

• utcomes, impact
• solve clinical problems, enhance clinical care, and improve health of

patients, families, and communities.

Grigsby RK & Thorndyke L. Perspective: Recognizing and Rewarding Clinical Scholarship. Acad Med 2011;86:127-131.

GRIGSBY AND THORNDYKE 2011

• systematic observation and scientifically based methods to identify,

describe, and solve clinical problems

• ccurs in throes of practice; potential for learning how to improve

clinical practice

• not limited solely to what occurs in the traditional clinical setting of the

hospital, outpatient clinic, or clinical practice

• broad scope, beyond a disease process, into lives of patients and

families, community arena

• ften interdisciplinary; knowledge and methods from other disciplines

to enhance understanding

• knowledge and expertise generated in clinical scholarship is of value.

Helps us anticipate trends, needs; track and manage processes,

• utcomes, impact
• solve clinical problems, enhance clinical care, and improve health of

patients, families, and communities.

PREVIOUS EVIDENCE OF SCHOLARSHIP IN THE SAME COMMUNITY LEARNING ENVIRONMENT

• A. Evidence of scholarly clinical practice in the learning environment

1. The general practice as an environment where scholarship

• ccurs

2. Learning in partnership with students 3. The responsibility and obligations associated with being a teacher 4. Improved systems 5. Reflective practice

• B. Improved level of care

Weston and Hudson 2014 Aust J Rural Health

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• Phase 3 research project

Phase 1 Phase 2 Phase 3 Phase 4 Year 1 Year 2 Year 3 Year 4

UOW MEDICAL DEGREE

• Each student undertakes a community-based project
• Own choice or interest
• Experience of continuum of research from design to data collection and

analysis to dissemination

• Topics are varied: include chronic disease management, cancer screening

rates, community perceptions of vaccination, health literacy, child health, access to health care in rural communities

• IS CLINICAL SCHOLARSHIP APPARENT DURING THIS RESEARCH ACTIVITY?

.

Research project in Phase 3

COMMUNITY-BASED STUDENT DRIVEN AUTHENTIC LEARNING

Outcomes for students

RESEARCH CAPABILITY - BEFORE

1 2 3 4 5

Defining a research question/idea Writing a research protocol Finding relevant literature Critically reviewing literature Using quantitative research methods Using qualitative research methods Analysing and interpreting results Writing and presenting a research report Publishing results Applying for research funding

Pre

Outcomes for students

RESEARCH CAPABILITY - AFTER

1 2 3 4 5

Defining a research question/idea Writing a research protocol Finding relevant literature Critically reviewing literature Using quantitative research methods Using qualitative research methods Analysing and interpreting results Writing and presenting a research report Publishing results Applying for research funding

Pre Post

CAN THE GRIGSBY& THORNDYKE FRAMEWORK BE APPLIED TO RESEARCH PROJECT EXPERIENCE IN THE COMMUNITY? Additional evidence of clinical scholarship during the LIC?

Abstracts of 12-month community research projects undertaken by 5 cohorts of medical students (n=328) were analysed for indicators of clinical scholarship based on a framework proposed by Grigsby and Thorndyke (2011) including:

• using scientific methods to address a clinical problem,
• potential for improved clinical practice,
• interdisciplinary practice,
• extending clinical impact beyond the practice into the lives of patients.

Project topics and collaborations as indicators of scholarship

1. SOLVING CLINICAL PROBLEMS Recommendations for antibiotic use to reduce port-a-cath infections A mobile app for improving accuracy of cardiac ausculation

EXAMPLES OF STUDENT RESEARCH PROJECTS

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• 2. IMPROVEMENTS IN CLINICAL PRACTICE

Education session with GPs on vitamin D resulted in more screening and more people prescribed Vitamin D Education on leg ulcer management Increase in flu vaccination rate with intervention Recommendations for ED management of STEMI, based on clinical audit Determining barriers to engagement in cervical cancer screening

STEMI: Segment Elevation Myocardial Infarction

EXAMPLES OF STUDENT RESEARCH PROJECTS

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• 3. INTERDISCIPLINARY PRACTICE

Study made recommendations to North Coast TB Association about TB antibiotic treatment Recommendations for improvement in breastfeeding services Early cessation of breastfeeding

EXAMPLES OF STUDENT RESEARCH PROJECTS

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• 4. BEYOND THE DISEASE PROCESS INTO THE LIVES OF

PATIENTS AND FAMILIES Technique check for use of puffer for COPD Opportunity to provide fact sheets on vaccination for children Development of a warfarin information sheet for patients Impact of community-based exercise on well-being

EXAMPLES OF STUDENT RESEARCH PROJECTS

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• Need for ED translation service in Emergency Department
• Interdisciplinary
• Into the lives of the community
• Improved outcomes
• All projects employ systematic observation and scientifically based

methods to identify, describe, and/or solve clinical problems or community issues

• Dissemination of results to practice staff, community
• 40 publications and conference presentations:

(~10% of students)

• Increasing capacity of general practice preceptors for research

Other examples

SCHOLARSHIP IN THE COMMUNITY PLACEMENT RESEARCH

Document title 21

• Medical students undertaking community-based research

during a longitudinal placement engage in clinical scholarship.

• Includes identification of ways to improve clinical practice

and patient health.

• Important step in engaging medical students with their

community, and development of the clinician researcher.

.

Conclusion

COMMUNITY-BASED RESEARCH PROJECT REPRESENTS CLINICAL SCHOLARSHIP viz. GRIGSBY AND THORNDYKE AND BOYER’S SCHOLARSHIP OF ENGAGEMENT

Questions